Provider Demographics
NPI:1154648855
Name:CESAR G. MANIQUIS, M.D., LTD.
Entity Type:Organization
Organization Name:CESAR G. MANIQUIS, M.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:G
Authorized Official - Last Name:MANIQUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-362-5650
Mailing Address - Street 1:303 E PARK AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2898
Mailing Address - Country:US
Mailing Address - Phone:847-362-5650
Mailing Address - Fax:847-362-5843
Practice Address - Street 1:303 E PARK AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2898
Practice Address - Country:US
Practice Address - Phone:847-362-5650
Practice Address - Fax:847-362-5843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3648767261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048767Medicaid
IL036048767Medicaid